CAJ | 학술논문

背景:移植肾活检病理学组织学早期诊断意义重大,单中心回顾性研究临床诊断与治疗较少.目的:通过对肾功能不全移植肾进行常规穿刺病理活检,根据病理诊断采取相应临床治疗方式,观察治疗效果,同时明确移植肾穿刺病理活检的安全性以及在临床诊治中的意义及其重要性.方法:选取解放军第309医院器官移植中心202例肾移植患者为研究对象,其中80例为肾移植后移植肾功能延迟恢复,122例肌酐不明原因升高.在 B 超引导下应用活检穿刺针行移植肾穿刺活检,对活检组织标本予以相应染色和病理组织学观察,并进行相应的临床治疗.结果与结论:穿刺组织中,除3例(1.5%)由于组织少难以诊断,其余病理诊断移植肾正常12例(5.9%),缺血再灌注损伤合并(或)急性肾小管坏死28例(13.9%),轻度钙调磷酸酶抑制剂类免疫抑制剂急性毒性损伤22例(10.9%),轻度钙调磷酸酶抑制剂类免疫抑制剂慢性毒性损伤12例(5.9%),超急性排斥反应1例(0.5%),疑为急性排斥反应29例(14.4%),急性 T 细胞性排斥反应34例(16.8%),急性抗体介导性排斥反应19例(9.4%),慢性 T 细胞介导排斥反应16例(7.9%),慢性 T 细胞介导排斥反应伴急性 T 细胞介导性排斥反应12例(5.9%),慢性抗体介导性排斥反应3例(1.5%),高血压因素4例(2.0%),间质纤维化和肾小管萎缩,未发现特定致病因素所致病变2例(1.0%),缺血性坏死2例(1.0%),移植后肾病复发3例(1.5%),C4d 免疫组化染色阳性23例(11.4%),未发现患者及移植肾的不良反应.
배경:이식신활검병이학조직학조기진단의의중대,단중심회고성연구림상진단여치료교소.목적:통과대신공능불전이식신진행상규천자병리활검,근거병리진단채취상응림상치료방식,관찰치료효과,동시명학이식신천자병리활검적안전성이급재림상진치중적의의급기중요성.방법:선취해방군제309의원기관이식중심202례신이식환자위연구대상,기중80례위신이식후이식신공능연지회복,122례기항불명원인승고.재 B 초인도하응용활검천자침행이식신천자활검,대활검조직표본여이상응염색화병리조직학관찰,병진행상응적림상치료.결과여결론:천자조직중,제3례(1.5%)유우조직소난이진단,기여병리진단이식신정상12례(5.9%),결혈재관주손상합병(혹)급성신소관배사28례(13.9%),경도개조린산매억제제류면역억제제급성독성손상22례(10.9%),경도개조린산매억제제류면역억제제만성독성손상12례(5.9%),초급성배척반응1례(0.5%),의위급성배척반응29례(14.4%),급성 T 세포성배척반응34례(16.8%),급성항체개도성배척반응19례(9.4%),만성 T 세포개도배척반응16례(7.9%),만성 T 세포개도배척반응반급성 T 세포개도성배척반응12례(5.9%),만성항체개도성배척반응3례(1.5%),고혈압인소4례(2.0%),간질섬유화화신소관위축,미발현특정치병인소소치병변2례(1.0%),결혈성배사2례(1.0%),이식후신병복발3례(1.5%),C4d 면역조화염색양성23례(11.4%),미발현환자급이식신적불량반응.
@@@@BACKGROUND: The kidney al ograft biopsy has great pathological and histological significance in the early diagnosis. However, the retrospective study of clinical diagnosis and treatment is rare. OBJECTIVE: To observe the effect of clinical treatments selected according to the pathological diagnosis which obtained through the wel ness puncture biopsy on insufficiency renal al ograft, and to identify the security and significance of grafted renal puncture biopsy in the clinical treatment. METHODS: 202 patients with renal transplantation were selected from the Organ Transplant Center, the 309th Hospital of Chinese PLA. Among them, 80 patients with delayed recovery of kidney function after kidney transplantation and 122 patients were found increasing creatinine content without explanation. With the guidance of B-ultrasound, a puncture needle was used to perform the kidney al ograft biopsy, and the biopsy specimens were stained and histopathological y by observed for the corresponding clinical treatment. RESULTS AND CONCLUSION: Al the patients were wel accepted by biopsy, except three patients (1.5%) were difficult to be diagnosed because of less tissue. Twelve patients (5.9%) had normal graft kidney, 28 patients (13.9%) suffered from ischemia/reperfusion injury combined with acute tubular necrosis, 22 patients (10.9%) appeared with mild acute toxic injury caused by calcium calcineurin inhibitor immunosuppressive drugs, 12 patients (5.9%) had mild chronic toxic injury caused by calcium calcineurin inhibitor immunosuppressive drugs, one patient (0.5%) appeared with hyperacute rejection, 29 patients (14.4%) were doubted with acute rejection, 34 patients (16.8%) suffered with acute T-cel rejection, 10 patients (9.4%) appeared with acute antibody-mediated rejection, 16 patients (7.9%) appeared with chronic T cel -mediated rejection, 12 patients (5.9%) suffered from chronic T cel -mediated rejection combined with acute T cel -mediated rejection, three patients (1.5%) displayed chronic antibody-mediated rejection, four patients (2.0%) showed hypertension and related factors, two patients (1.0%) suffered from interstitial fibrosis and tubular atrophy without specific risk factors caused lesions, two patients (1.0%) presented with ischemic necrosis, three patients (1.5%) presented with nephropathy recurrence after transplantation and 23 patients were positive for C4d immunohistochemical staining. No adverse reaction was found in the patients or in the graft kidney.